Possible Markers for Neuro Problems Found in Patients with Sleep Disorder

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Brain imaging may help identify which patients with REM sleep behavior disorder -- characterized by excessive movement during dreaming -- could be at short-term risk for developing a neurodegenerative condition, according to Spanish researchers.

In a study of 43 patients, two neuroimaging changes predicted the development of Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy with 100% sensitivity and 55% specificity, Alex Iranzo, MD, of Hospital Clinic Barcelona, and colleagues, reported online inThe Lancet Neurology.

The two potential markers were striatal dopamine dysfunction detected with single photon emission CT (SPECT) and midbrain hyperechogenicity detected with transcranial sonography.

Combined use of the two techniques "is a potential strategy for early identification of [REM sleep behavior disorder] individuals who are at increased short-term risk for development of a synucleinopathy," Iranzo and co-authors wrote, adding that extended follow-up is needed to confirm the findings.

Action Points

Explain to interested patients that brain imaging may help identify which patients with REM sleep behavior disorder -- characterized by excessive movement during dreaming -- could be at short-term risk for developing a neurodegenerative condition such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy.

Further explain that the two neuroimaging changes found to be predictive were striatal dopamine dysfunction, detected with single photon emission CT (SPECT), and midbrain hyperechogenicity, detected with transcranial sonography.

Early identification of at-risk individuals would allow researchers to study the preclinical phases of the synucleinopathies and better target investigational disease-modifying therapies, they noted.

"If [these patients] were regularly followed-up, the diagnosis of a neurodegenerative syndrome could be established at the earliest possible time, which would allow the initiation of treatment that could result in improved quality of life," Iranzo and colleagues wrote.

Previous studies have suggested a link between REM sleep behavior disorder and the development of neurodegenerative conditions several years or even decades later. It is unknown, however, which patients are at risk.

Both SPECT-detected striatal dopamine dysfunction and midbrain hyperechogenicity have been found in patients with Parkinson's disease, even in the preclinical phase. So Iranzo and colleagues wanted to find out whether they could serve as markers of risk in patients with REM sleep behavior disorder.

They imaged 43 patients who were treated for the sleep disorder at their center and compared the findings with healthy controls (18 for the SPECT analysis and 149 for the transcranial sonography analysis).

After a follow-up of 2.5 years, SPECT detected striatal dopamine dysfunction in 40% of patients, which was significantly different from the controls (P=0.045). Transcranial sonography detected substantia nigra hyperechogenicity in 36% of patients, compared with 11% of controls (P=0.0002).

Nearly two-thirds of the patients had at least one of the abnormal findings. Of these, 30% developed a neurodegenerative disorder -- five had Parkinson's disease, two had dementia with Lewy bodies, and one had multiple system atrophy.

None of the patients who had normal neuroimaging results developed a synucleinopathy.

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